A judge sided with transgender workers in a Wisconsin health insurance fight

A Wisconsin federal judge ruled in favor of two transgender women who challenged the state's insurance ban o...

Posted: Sep 21, 2018 11:25 AM
Updated: Sep 21, 2018 11:25 AM

A Wisconsin federal judge ruled in favor of two transgender women who challenged the state's insurance ban on coverage for gender-affirming care.

US District Judge William Conley said in his order that the exclusion in state employee insurance plans violates federal anti-discrimination laws.

Business and industry sectors

Business, economy and trade

Continents and regions

Health and medical

Health care

Insurance

Midwestern United States

North America

Sex and gender issues

Society

The Americas

Transgender persons

United States

Wisconsin

Discrimination

Medical treatments and procedures

Societal issues

Surgery

Civil servants

Labor and employment

State employees

Workers and professionals

Decisions and rulings

Law and legal system

Trial and procedure

According to their lawsuit, University of Wisconsin-Madison graduate student Alina Boyden and University of Wisconsin Medical School researcher Shannon Andrews suffer from gender dysphoria -- the diagnostic term for the distress a person feels when their gender identity does not match the sex they were assigned at birth.

The women -- both state employees -- sued Wisconsin's insurance board and employee trust after they were denied coverage for treatment their physicians deem medically necessary, according to court documents.

In its defense, the state relied on a benefits exclusion for "procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment," according to court documents.

In 2016, the state amended the terms of coverage in employee plans to start offering gender-affirming care in January 2017. Then, two days before the coverage was to go into effect, the state reinstated the exclusion. The state cited a federal court ruling in Texas that halted federal enforcement of anti-discrimination protections under the Affordable Care Act for transgender and gender-nonconforming patients.

The state argued that requiring it to cover such treatment would "insert the State directly into the business of encouraging surgeries meant to conform peoples' appearances to their own perceived sex stereotypes."

But Conley said the state's argument "appears unhinged from reality."

He said the exclusion constitutes sex-based discrimination in violation of the federal employment law, Title VII, as well as section 1557 of the Affordable Care Act.

He pointed to medical evidence and testimony that not all transgender or gender-nonconforming people need surgery to treat dysphoria. Instead, he said in his ruling, the exclusion encourages sex stereotyping by limiting the availability of gender-affirming treatment, "if not rendering it economically infeasible," by requiring transgender individuals to maintain the physical characteristics of the sex they were assigned at what he refers to as "natal birth."

"The Exclusion entrenches the belief that transgender individuals must preserve the genitalia and other physical attributes of their natal birth over not just personal preference, but specific medical and psychological recommendations to the contrary," Conley said.

"In this way, defendants' assertion that the Exclusion does not restrict transgender individuals from living their gender identity is entirely disingenuous, at least for some portion of that population who will suffer from profound and debilitating gender dysphoria without the necessary medical transition."

The state also cited the cost of providing coverage as a reason for restoring the exclusion. The judge pointed out that its own actuarial consultant estimated that the coverage would cost the state about $300,000 in annual costs, amounting to an extra $0.04 to $0.10 per member per month, representing about 0.1% to 0.2% of the total cost of providing health insurance to state employees.

Andrews paid out of pocket for her surgery, a move that she called life-saving.

"I'm pleased the court recognized that denying coverage for my medical care was sex discrimination. I, personally, was lucky to be in a position to have retirement funds and savings I could take out to fund my medical care, but had I been less fortunate I would not be alive today," said Andrews.

"Today, I feel vindicated the court recognized what the state did was wrong," she said. "I hope that this will be a powerful signal that trans people are not fair game for discrimination and that our lives and health are not a political football."

The state did not reply to requests for comment Thursday night.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 319948

Reported Deaths: 7371
CountyCasesDeaths
DeSoto22285267
Hinds20719421
Harrison18431317
Rankin13901282
Jackson13718248
Madison10263224
Lee10059176
Jones8467167
Forrest7832153
Lauderdale7261242
Lowndes6517150
Lamar635188
Lafayette6313121
Washington5425137
Bolivar4841133
Panola4670110
Oktibbeha466198
Pearl River4605147
Marshall4574105
Warren4440121
Pontotoc425873
Monroe4157135
Union415777
Neshoba4063179
Lincoln4008112
Hancock386987
Leflore3515125
Tate342486
Sunflower339491
Pike3371111
Alcorn327272
Scott320374
Yazoo314171
Adams308086
Itawamba305178
Copiah299966
Coahoma298784
Simpson298589
Tippah291968
Prentiss284161
Leake272074
Marion271280
Covington267283
Wayne264642
Grenada264087
George252251
Newton248663
Tishomingo231868
Winston230181
Jasper222148
Attala215073
Chickasaw210559
Holmes190474
Stone188433
Clay187954
Tallahatchie180041
Clarke178980
Calhoun174132
Yalobusha167840
Smith164134
Walthall135347
Greene131834
Lawrence131124
Montgomery128643
Noxubee128034
Perry127238
Amite126242
Carroll122330
Webster115032
Jefferson Davis108234
Tunica108127
Claiborne103130
Benton102325
Humphreys97533
Kemper96629
Franklin85023
Quitman82216
Choctaw79118
Wilkinson69632
Jefferson66228
Sharkey50917
Issaquena1696
Unassigned00

Alabama Coronavirus Cases

Cases: 548657

Reported Deaths: 11306
CountyCasesDeaths
Jefferson810031566
Mobile42105831
Madison35690525
Tuscaloosa26173458
Shelby25607254
Montgomery25081614
Baldwin21868314
Lee16278176
Calhoun14719327
Morgan14629285
Etowah14175364
Marshall12453230
Houston10781287
Elmore10293214
Limestone10179157
St. Clair10162251
Cullman9952201
Lauderdale9603250
DeKalb8972190
Talladega8460184
Walker7338280
Autauga7241113
Blount6945139
Jackson6932113
Colbert6413140
Coffee5635127
Dale4928116
Russell454841
Chilton4476116
Franklin431382
Covington4275122
Tallapoosa4138155
Escambia401680
Chambers3728124
Dallas3607158
Clarke353061
Marion3240107
Pike314378
Lawrence3133100
Winston283472
Bibb268564
Geneva257981
Marengo250565
Pickens236962
Barbour234559
Hale227278
Butler224271
Fayette218862
Henry194543
Randolph187544
Cherokee187345
Monroe180041
Washington170539
Macon163051
Clay160059
Crenshaw155957
Cleburne153444
Lamar146837
Lowndes142254
Wilcox126930
Bullock124342
Conecuh113630
Coosa111729
Perry108626
Sumter105732
Greene93634
Choctaw62125
Out of AL00
Unassigned00
Tupelo
Clear
70° wxIcon
Hi: 92° Lo: 70°
Feels Like: 70°
Columbus
Clear
69° wxIcon
Hi: 90° Lo: 69°
Feels Like: 69°
Oxford
Clear
68° wxIcon
Hi: 91° Lo: 65°
Feels Like: 68°
Starkville
Clear
68° wxIcon
Hi: 90° Lo: 67°
Feels Like: 68°
Tropical Depression Claudette has now moved into Alabama and Georgia, leaving with some cloud cover but dry conditions. Most of us will stay dry through this Father's Day but some spotty showers will likely through the late afternoon.
WTVA Radar
WTVA Temperatures
WTVA Severe Weather